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Testicular Cancer Staging: TNM Classification

Testicular Cancer staging helps to determine the disease prognosis and to select an appropriate treatment strategy. TNM is the most commonly used system for staging testicular cancer.

“T” stands for “Tumor Size”, “N” for “Lymph Nodes”, “M” for “Metastasis”, and “S” stands for “Serum level of tumor markers”. Numbers and/or letters after T (is, 1, 2, 3, and 4), N (0, 1, 2, and 3), M (0, 1a, and 1b), and S (x, 0, 1, 2, and 3) provide more details about each of these factors.

Once T, N, M, and S categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

Testicular Cancer - Staging - Infographic
Testicular Cancer - Staging
Testicular Cancer - T Staging - Infographics
Testicular Cancer - T Staging
Testicular Cancer - N and M Staging - Infographics
Testicular Cancer - N and M Staging

Before discussing the staging, let's understand the NORMAL ANATOMY of testis and surrounding structures.

STAGE TNM DESCRIPTION
0 Tis N0 M0 S0 The cancer cells are present only in the seminiferous tubules (small tube-like structures inside the testes). No spread to regional lymph nodes or distant body parts. Normal tumor marker levels.
IA T1 N0 M0 S0 Tumor limited to testis/epididymis and has invaded up to the tunica albuginea but has not grown into tunica vaginalis or nearby blood vessels/lymphatics. No spread to regional lymph nodes or distant body parts. Normal tumor marker levels.
IB T2 N0 M0 S0 Tumor limited to testis/epididymis and has invaded up to the tunica vaginalis or blood vessels/lymphatics involvement by the tumor. No spread to regional lymph nodes or distant body parts. Normal tumor marker levels.
OR
T3 N0 M0 S0 Tumor has invaded the spermatic cord with or without blood vessels/lymphatics involvement. No spread to regional lymph nodes or distant body parts. Normal tumor marker levels.
OR
T4 N0 M0 S0 Tumor has invaded the scrotum with or without blood vessels/lymphatics involvement. No spread to regional lymph nodes or distant body parts. Normal tumor marker levels.
IS Any T N0 M0 S1-3 An elevated level of at least one of the 3 tumor markers with a tumor limited to scrotum without spread to nearby lymph nodes or distant sites.
IIA Any T N1 M0 S0-1 Tumor spread to single or multiple regional lymph node(s) none >2 cm in greatest dimension, without spread to distant body parts. Normal tumor marker levels or elevated [LDH <1.5 × upper limit of normal, and beta-HCG <5000 mIU/ml, and AFP <1000 ng/ml].
IIB Any T N2 M0 S0-1 Tumor spread to single or multiple regional lymph node(s), any one >2 cm but </=5 cm in greatest dimension, without spread to distant body parts. Normal tumor marker levels or elevated [LDH <1.5 × upper limit of normal, and beta-HCG <5000 mIU/ml, and AFP <1000 ng/ml].
IIC Any T N3 M0 S0-1 Tumor spread to lymph node mass >5 cm in greatest dimension without spread to distant body parts Normal tumor marker levels or elevated [LDH <1.5 × upper limit of normal, and beta-HCG <5000 mIU/ml, and AFP <1000 ng/ml].
IIIA Any T Any N M1a S0-1 Tumor may have spread to regional lymph nodes, with spread to non-regional lymph nodes or lungs. Normal tumor marker levels or elevated [LDH <1.5 × upper limit of normal, and beta-HCG <5000 mIU/ml, and AFP <1000 ng/ml].
IIIB Any T N1-3 M0 S2 Tumor spread to regional lymph nodes without distant spread. Tumor markers are elevated (LDH=1.5-10 × upper limit of normal, or beta-HCG=5000-50000 mIU/ml, or AFP=1000-10000 ng/ml).
OR
Any T Any N M1a S2 Tumor may have spread to regional lymph nodes, with spread to non-regional lymph nodes or lungs. Tumor markers are elevated (LDH=1.5-10 × upper limit of normal, or beta-HCG=5000-50000 mIU/ml, or AFP=1000-10000 ng/ml).
IIIC Any T N1-3 M0 S3 Tumor spread to regional lymph nodes without distant spread. Tumor markers are elevated [LDH >10 × upper limit of normal, or beta-HCG >50000 mIU/ml, or AFP >10000 ng/ml].
OR
Any T Any N M1a S3 Tumor may have spread to regional lymph nodes, with spread to non-regional lymph nodes or lungs. Tumor markers are elevated [LDH >10 × upper limit of normal, or beta-HCG >50000 mIU/ml, or AFP >10000 ng/ml].
OR
Any T Any N M1b Any S Tumor may have spread to regional lymph nodes, with spread to distant sites other than non-regional lymph nodes or lungs. Tumor markers may be normal or elevated.

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In the following video, Cancerbro explains the TNM STAGING of testicular cancer in an easy to understand manner.

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